Justice Department Joins Medicare Fraud Suit Against Nursing Home Chain
The Justice Department has joined a whistle-blower lawsuit charging Integrated Health Services Inc., one of the nation's largest nursing home chains, with Medicare fraud, the Baltimore Sun reports. Yesterday, Thelma Quince Colbert, lead assistant U.S. attorney for civil enforcement in Fort Worth, Texas, revealed that her office filed notice last Friday, announcing plans to "intervene" and effectively "take over" the case in U.S. District Court in Dallas. IHS officials and attorneys declined to comment.
Last year, Carolyne Gray, a social worker at an IHS facility in Dallas, filed suit against IHS, alleging that the "acute long term care" facility admitted patients who "did not need its level of care," "inflated" patient complaint problems and billed Medicare for services "never delivered" (Salganik, Baltimore Sun, 12/13). In addition, the lawsuit charges that Dr. Sam Jahani, the former medical director at the IHS Dallas facility, required physical therapy for all patients, regardless of "medical necessity." Gray also alleges that IHS committed similar acts of fraud at facilities in Amarillo and Lubbock (Conklin, Dallas Morning News, 12/13).
According to Bonny Harbinger, Gray's attorney, the fraudulent claims could run as high as "tens of millions of dollars." Colbert could not confirm the figure, noting that auditors would continue to review IHS' records to "define the damages." As a whistle-blower, Gray stands to receive between 15% and 25% of any damages that the government recovers. Colbert also said that investigators have "not yet determined" whether other IHS facilities participated in acts of Medicare fraud. IHS has more than 350 facilities across the nation.
A Case With 'Merit'
John Bentivoglio, a former Justice Department health fraud chief, said that the agency intervenes in only one-fourth to one-third of fraud cases. Pursuing this case "means the department has looked at it and believes it has merit," he said, adding, "Usually, they don't pursue it unless they feel it's a solid case" (Baltimore Sun, 12/13). Harbinger said that Gray called the Medicare Fraud Hotline several times before filing the suit, but received "little response." She added, "[Gray] just wanted (the abuse) to stop and she was concerned it would be pushed under the rug" (Dallas Morning News, 12/13).